Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right

Anne S. Siegmund, Petronella G. Pieper, Barbara J. M. Mulder, Gertjan Tj. Sieswerda, Arie P. J. van Dijk, Jolien W. Roos-Hesselink, Monique R. M. Jongbloed, Thelma C. Konings, Berto J. Bouma, Henk Groen, Krystyna M. Sollie-Szarynska, Marlies A. M. Kampman, Caterina M. Bilardo, Dirk J. van Veldhuisen, Jan J. J. Aalberts

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: Little is known about the course of echocardiographic parameters used for the evaluation of valvular heart disease (VHD) during pregnancy, hampering interpretation of possible changes (physiological vs. pathophysiological). Therefore we studied the course of these parameters and ventricular function in pregnant women with aortic and pulmonary VHD. Methods: The cohort comprised 66 pregnant women enrolled in the prospective ZAHARA studies or evaluated by an identical protocol who had pulmonary VHD or aortic VHD (stenosis/prosthetic valve). The control group comprised 46 healthy pregnant women. Echocardiography was performed preconception, during pregnancy and 1 year postpartum. Peak gradient, mean gradient, aortic valve area (AVA)/effective orifice area (EOA), left ventricular ejection fraction (LVEF) and right ventricular function (RVF; TAPSE) were assessed. Results: Peak and mean gradients increased during pregnancy compared to preconception in women with aortic VHD and controls (p < 0.0125), but not in women with pulmonary VHD. AVA/EOA remained unchanged. Preconception and postpartum gradients were comparable in all groups. Mean LVEF was normal in pregnant women with VHD and controls. Mean TAPSE was lower (p < 0.001) in women with pulmonary VHD compared to women with aortic VHD and controls (<20 mm vs. ≥23 mm; p < 0.001). In women with pulmonary VHD a decrease of TAPSE was observed during pregnancy (p = 0.005). Conclusion: Physiological changes during pregnancy lead to increased Doppler gradients in women with aortic VHD. This increase was not found in women with pulmonary VHD, probably caused by impaired RVF. Therefore, evaluation of RVF during pregnancy might be important to prevent underestimation of the degree of stenosis.
Original languageEnglish
JournalInternational Journal of Cardiology
DOIs
Publication statusE-pub ahead of print - 16 Nov 2019

Cite this

Siegmund, Anne S. ; Pieper, Petronella G. ; Mulder, Barbara J. M. ; Sieswerda, Gertjan Tj. ; van Dijk, Arie P. J. ; Roos-Hesselink, Jolien W. ; Jongbloed, Monique R. M. ; Konings, Thelma C. ; Bouma, Berto J. ; Groen, Henk ; Sollie-Szarynska, Krystyna M. ; Kampman, Marlies A. M. ; Bilardo, Caterina M. ; van Veldhuisen, Dirk J. ; Aalberts, Jan J. J. / Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right. In: International Journal of Cardiology. 2019.
@article{e944024b744e4ad6aa3841a8b621f664,
title = "Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right",
abstract = "Objective: Little is known about the course of echocardiographic parameters used for the evaluation of valvular heart disease (VHD) during pregnancy, hampering interpretation of possible changes (physiological vs. pathophysiological). Therefore we studied the course of these parameters and ventricular function in pregnant women with aortic and pulmonary VHD. Methods: The cohort comprised 66 pregnant women enrolled in the prospective ZAHARA studies or evaluated by an identical protocol who had pulmonary VHD or aortic VHD (stenosis/prosthetic valve). The control group comprised 46 healthy pregnant women. Echocardiography was performed preconception, during pregnancy and 1 year postpartum. Peak gradient, mean gradient, aortic valve area (AVA)/effective orifice area (EOA), left ventricular ejection fraction (LVEF) and right ventricular function (RVF; TAPSE) were assessed. Results: Peak and mean gradients increased during pregnancy compared to preconception in women with aortic VHD and controls (p < 0.0125), but not in women with pulmonary VHD. AVA/EOA remained unchanged. Preconception and postpartum gradients were comparable in all groups. Mean LVEF was normal in pregnant women with VHD and controls. Mean TAPSE was lower (p < 0.001) in women with pulmonary VHD compared to women with aortic VHD and controls (<20 mm vs. ≥23 mm; p < 0.001). In women with pulmonary VHD a decrease of TAPSE was observed during pregnancy (p = 0.005). Conclusion: Physiological changes during pregnancy lead to increased Doppler gradients in women with aortic VHD. This increase was not found in women with pulmonary VHD, probably caused by impaired RVF. Therefore, evaluation of RVF during pregnancy might be important to prevent underestimation of the degree of stenosis.",
author = "Siegmund, {Anne S.} and Pieper, {Petronella G.} and Mulder, {Barbara J. M.} and Sieswerda, {Gertjan Tj.} and {van Dijk}, {Arie P. J.} and Roos-Hesselink, {Jolien W.} and Jongbloed, {Monique R. M.} and Konings, {Thelma C.} and Bouma, {Berto J.} and Henk Groen and Sollie-Szarynska, {Krystyna M.} and Kampman, {Marlies A. M.} and Bilardo, {Caterina M.} and {van Veldhuisen}, {Dirk J.} and Aalberts, {Jan J. J.}",
year = "2019",
month = "11",
day = "16",
doi = "10.1016/j.ijcard.2019.11.118",
language = "English",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

Siegmund, AS, Pieper, PG, Mulder, BJM, Sieswerda, GT, van Dijk, APJ, Roos-Hesselink, JW, Jongbloed, MRM, Konings, TC, Bouma, BJ, Groen, H, Sollie-Szarynska, KM, Kampman, MAM, Bilardo, CM, van Veldhuisen, DJ & Aalberts, JJJ 2019, 'Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right' International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2019.11.118

Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right. / Siegmund, Anne S.; Pieper, Petronella G.; Mulder, Barbara J. M.; Sieswerda, Gertjan Tj.; van Dijk, Arie P. J.; Roos-Hesselink, Jolien W.; Jongbloed, Monique R. M.; Konings, Thelma C.; Bouma, Berto J.; Groen, Henk; Sollie-Szarynska, Krystyna M.; Kampman, Marlies A. M.; Bilardo, Caterina M.; van Veldhuisen, Dirk J.; Aalberts, Jan J. J.

In: International Journal of Cardiology, 16.11.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right

AU - Siegmund, Anne S.

AU - Pieper, Petronella G.

AU - Mulder, Barbara J. M.

AU - Sieswerda, Gertjan Tj.

AU - van Dijk, Arie P. J.

AU - Roos-Hesselink, Jolien W.

AU - Jongbloed, Monique R. M.

AU - Konings, Thelma C.

AU - Bouma, Berto J.

AU - Groen, Henk

AU - Sollie-Szarynska, Krystyna M.

AU - Kampman, Marlies A. M.

AU - Bilardo, Caterina M.

AU - van Veldhuisen, Dirk J.

AU - Aalberts, Jan J. J.

PY - 2019/11/16

Y1 - 2019/11/16

N2 - Objective: Little is known about the course of echocardiographic parameters used for the evaluation of valvular heart disease (VHD) during pregnancy, hampering interpretation of possible changes (physiological vs. pathophysiological). Therefore we studied the course of these parameters and ventricular function in pregnant women with aortic and pulmonary VHD. Methods: The cohort comprised 66 pregnant women enrolled in the prospective ZAHARA studies or evaluated by an identical protocol who had pulmonary VHD or aortic VHD (stenosis/prosthetic valve). The control group comprised 46 healthy pregnant women. Echocardiography was performed preconception, during pregnancy and 1 year postpartum. Peak gradient, mean gradient, aortic valve area (AVA)/effective orifice area (EOA), left ventricular ejection fraction (LVEF) and right ventricular function (RVF; TAPSE) were assessed. Results: Peak and mean gradients increased during pregnancy compared to preconception in women with aortic VHD and controls (p < 0.0125), but not in women with pulmonary VHD. AVA/EOA remained unchanged. Preconception and postpartum gradients were comparable in all groups. Mean LVEF was normal in pregnant women with VHD and controls. Mean TAPSE was lower (p < 0.001) in women with pulmonary VHD compared to women with aortic VHD and controls (<20 mm vs. ≥23 mm; p < 0.001). In women with pulmonary VHD a decrease of TAPSE was observed during pregnancy (p = 0.005). Conclusion: Physiological changes during pregnancy lead to increased Doppler gradients in women with aortic VHD. This increase was not found in women with pulmonary VHD, probably caused by impaired RVF. Therefore, evaluation of RVF during pregnancy might be important to prevent underestimation of the degree of stenosis.

AB - Objective: Little is known about the course of echocardiographic parameters used for the evaluation of valvular heart disease (VHD) during pregnancy, hampering interpretation of possible changes (physiological vs. pathophysiological). Therefore we studied the course of these parameters and ventricular function in pregnant women with aortic and pulmonary VHD. Methods: The cohort comprised 66 pregnant women enrolled in the prospective ZAHARA studies or evaluated by an identical protocol who had pulmonary VHD or aortic VHD (stenosis/prosthetic valve). The control group comprised 46 healthy pregnant women. Echocardiography was performed preconception, during pregnancy and 1 year postpartum. Peak gradient, mean gradient, aortic valve area (AVA)/effective orifice area (EOA), left ventricular ejection fraction (LVEF) and right ventricular function (RVF; TAPSE) were assessed. Results: Peak and mean gradients increased during pregnancy compared to preconception in women with aortic VHD and controls (p < 0.0125), but not in women with pulmonary VHD. AVA/EOA remained unchanged. Preconception and postpartum gradients were comparable in all groups. Mean LVEF was normal in pregnant women with VHD and controls. Mean TAPSE was lower (p < 0.001) in women with pulmonary VHD compared to women with aortic VHD and controls (<20 mm vs. ≥23 mm; p < 0.001). In women with pulmonary VHD a decrease of TAPSE was observed during pregnancy (p = 0.005). Conclusion: Physiological changes during pregnancy lead to increased Doppler gradients in women with aortic VHD. This increase was not found in women with pulmonary VHD, probably caused by impaired RVF. Therefore, evaluation of RVF during pregnancy might be important to prevent underestimation of the degree of stenosis.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85075881177&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31785953

U2 - 10.1016/j.ijcard.2019.11.118

DO - 10.1016/j.ijcard.2019.11.118

M3 - Article

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -